U.S. Department of Agriculture - Forest Service Bridge Use Application and Permit.pdf
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This is a Bridge Use Application and Permit form issued by the U.S. Department of Agriculture Forest Service under 36 CFR 261.12 and 261.54(c). The form is a template used to request authorization for vehicles to traverse designated bridges on National Forest System lands for timber sales, construction contracts, or other purposes.
The applicant must provide identifying information including name, address, phone, and fax number, along with the reason for bridge use and desired travel dates and routes. The vehicle section requires comprehensive specifications including total gross weight, maximum dimensions (length, width, height), license number, and detailed axle information such as axle spacing, axle load, axle width, tire width, number of tires per axle, and tire size for up to ten axles. A registered professional engineer must evaluate the bridge(s) for the specified vehicle and sign the form. The Forest Bridge Inspection Program Manager and Regional Bridge Engineer (R-6) must provide recommendations and concurrence before final approval. The Forest Supervisor grants final approval of the permit, which specifies the designated bridge(s), effective dates, and any provisions or attachments. The form requires signatures and dates from the applicant, engineer, program manager, regional engineer, and forest supervisor.
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U.S. DEPARTMENT OF AGRICULTURE – FOREST SERVICE
BRIDGE USE APPLICATION AND PERMIT
36CFR 261.12, and 261.54(c)
DATE RECEIVED:__________________ EFFECTIVE DATES OF PERMIT (Section for Forest Servcie Use Only) PERMIT NO.: _____________________ BEGINNING: ______________ TERMINATING: ______________ EXCLUDING: _____________
PERMITTEE/APPLICANT: ______________________________________ PHONE: _______________ ADDRESS: ____________________________________________________ FAX: _______________
REASON FOR PERMIT: TIMBER SALE:________________________________________________
CONSTRUCTION CONTRACT: __________________________________
OTHER: _____________________________________________________
DESIRED TRAVEL DATES: BEGIN: ____________ END: _____________
DESIRED TRAVEL ROUTE (Road #’s, Termini & Bridges): ___________________________________ TYPE OF VEHICLE: __________________________________________________________________
TOTAL GROSS WEIGHT:______________ POUNDS LICENSE NO: ____________ STATE: ____
MAXIMUM DIMENSIONS: LENGTH: ______________WIDTH: ____________ HEIGHT: ___________
VEHICLE DESCRIPTION
AXLE WIDTH TIRE WIDTH (OUT-OUT) NO. OF
AXLE AXLE SPACING AXLE LOAD (OUT – OUT) PER WHEEL LINE TIRES TIRE
NO. FEET & INCHES POUNDS FEET INCHES INCHES PER AXLE SIZE
1 P1 ___________ _____ ′ _____ ″ _______″ _____ _______ D1 _____ ′ _____ ″ 2 P2 ___________ _____ ′ _____ ″ _______″ _____ _______ D2 _____ ′ _____ ″ 3 P3 ___________ _____ ′ _____ ″ _______″ _____ _______ D3 _____ ′ _____ ″ 4 P4 ___________ _____ ′ _____ ″ _______″ _____ _______ D4 _____ ′ _____ ″ 5 P5 ___________ _____ ′ _____ ″ _______″ _____ _______ D5 _____ ′ _____ ″ 6 P6 ___________ _____ ′ _____ ″ _______″ _____ _______ D6 _____ ′ _____ ″ 7 P7 ___________ _____ ′ _____ ″ _______″ _____ _______ D7 _____ ′ _____ ″ 8 P8 ___________ _____ ′ _____ ″ _______″ _____ _______ D8 _____ ′ _____ ″ 9 P9 ___________ _____ ′ _____ ″ _______″ _____ _______ D9 _____ ′ _____ ″ 10 P10___________ _____ ′ _____ ″ _______″ _____ _______
SIGNATURE OF APPLICANT: NAME OF REGISTERED PROFESSIONAL ENGINEER EVALUATING BRIDGE(S)
FOR ABOVE VEHICLE: _______________________________________________(PE)
SIGNATURE: _______________________________
FOREST BRIDGE INSPECTION PROGRAM MANAGER RECOMMENDATION
__________________________________________ AND REGIONAL BRIDGE ENGINEER CONCURRENCE (Print Name) SUBJECT TO PROVISIONS AND ATTACHMENTS INCLUDED HEREIN
TITLE: _____________________________________ SIGNATURE: ___________________________________ DATE: _________ Forest Bridge Program Manager
DATE: ________________________ SIGNATURE: ___________________________________ DATE: _________ R-6 Regional Bridge Engineer
APPROVAL OF PERMIT
PERMISSION IS HEREBY GIVEN TO THE ABOVE APPLICANT FOR THE USE OF THE DESIGNATED BRIDGE(S) IN THE MANNER DESCRIBED, SUBJECT TO THE PROVISIONS AND ATTACHMENTS INCLUDED WITH THIS PERMIT
SIGNATURE: ____________________________________________ DATE: _____________ __________
TITLE: ________________________________________________________________________________ Forest Supervisor
36CFR 261.12, and 261.54(c)
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